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Long bone fracture complication
- 2. L.O. Complication of long bone fracture ?
- 3. Complicated Divided: Local - Immediate - Early - Delay Systemic - Immediate - Early
- 4. Classification Immediate complication Local immediate complication Systemic immediate complication -Injury to major vessels. -Injury to muscles and tendons. -Injury to joints. -Injury to nerve. Hypovolemic shock (Hemorrhage)
- 5. Classification Early complication Local Early complication Systemic Early complication Compartment syndrome. Infection. - Hypovolemic shock - ARDS - Fat embolism syndrome - Deep vein thrombosis - Pulmonary Embolism - Crush syndrome - DIC - Aseptic traumatic fever - Septicemia
- 6. Classification Late complication . Imperfect union of the fracture (Deformity) Delayed union Non union Mal union Cross union
- 7. BLOOD VESSELS INJURY BLOODVESSELS :VASCULAR INJURY Injury to the artery is classically associated with several specific fractures involving such sites as : Clavicle bone sub clavicle artery. Supracondylar region of the elbow brachial artery. Femoral shaft femoral artery . Around the kneeThe popliteal artery .
- 8. NERVE INJURY Nerve can damage in 3 ways: • Compressed. • Contused. • Stretched.
- 9. ADULT RESPIRATORY DISTRESS SYNDROME (ARDS) known as :Shock lung or wet lung. Follow: slight fluid overload. Edema and electrolyte retention secondary to the trauma also contribute to it. Treatment is by oxygen and ventilation.
- 10. FAT EMBOLI SYNDROME (FES) Mechanical blockage of blood vessels by circulating fat particles . Occurs following ( Long bone fracture, pelvic fracture, total hip arthroplasty. ) FAT EMBOLI SYNDROME (FES)
- 11. FAT EMBOLI SYNDROME (FES) Signs and symptoms can appear 12-72 hours post injury Change in mental status Respiratory distress Petechial of skin & mucosa. Diagnostics: ( No specific labs test ) Fat globules may be detected in blood, urine or sputum PO2 drops to < 50 mm HG Chest X Ray with diffuse “snowstorm” effect
- 12. DEEPVEIN THROMBOSIS & PULMONARY EMBOLISM Formation of fibrin leads to development of a thrombus (fibrin clot) Embolus can enter pulmonary circulation and perfusion distal to the embolus can be partially or completely occluded. (DVT) & (PE)
- 13. DEEPVEIN THROMBOSIS & PULMONARY EMBOLISM DVT: Clinical manifestations Unilateral swelling of thigh/lower leg Discomfort in leg Erythema Warmth Tenderness Investigation PEDVT • Pulmonary angiography • CT scan • Contrast venography • Doppler ultrasonography
- 14. CRUSH SYNDROME Also known as traumatic rhabdomyolysis. It is compression of extremities or other parts of the body that causes muscle swelling and/or neurological disturbances in the affected areas of the body. It is characterized by major shock and renal failure after a crushing injury to skeletal muscle. CRUSH SYNDROME
- 15. COMPARTMENT SYNDROME A condition in which the circulation and function of tissues within a closed space compromised by an increased pressure within that space. RISK FACTORS COMPARTMENT SYNDROME Internal FactorsExternal Force • Bleeding • Swelling/edema • Tight cast • Tight dressing • Prolonged compression • Crush injuries
- 17. COMPARTMENT SYNDROME DIAGNOSTICS: Intra-compartmental pressure monitor Pressures of 30-45 mm HG a concern.
- 18. Problems in Bone Healing Delayed union • Less than 6 months Non union • More than 6 months Malunion • Healing with deformity Cross Union • happens in very specific area Avascular necrosis • Bone death due to interruption of blood supply Problems in Bone Healing
- 20. Summary Local - Immediate - Early - Delay Systemic - Immediate - Early
- 22. Reference
Editor's Notes
- - local :could be at the site of injury or surrounding systematic : involve all the body #systemic: no deled complications at all. more dangerous than the local The worst things in local complication ampulate the limb - the worst things in systemic complication death
- we will have bleeding wither becuz of bleeding from bone itself or fracture it self some times had sharp bone end cutting the blood vessels Systemic immediate complication occur as result of Hypovolemic shock occur as result of (Hemorrhage) occur as result bleeding from bone itsel
- (Adult respiratory distress syndrome) Disseminated Intravascular Septicaemia in open fracture Compartment syndrome most dangerous early and local complication
- Relatively uncommon event when associated with fractures. When it occurs, it is always an emergent situation
- Neuropraxia. Mild injury of the axon so , anatomically intact and physiologically nonfunctional Death of the axon does not occur. The condition is generally caused by pressure or contusion and usually improves by itself in a few weeks. Axonotmesis. Sever injury in the axon Is an anatomic disruption of the axon in its sheath. Improvement follows regeneration, the axon growing at a slow rate of 1 mm The patient may restore function even if it got lost but partial not complete Neurotmesis. Severe injeryIs an anatomic disruption of the nerve itself. Minimal chance for recovery
- what happened ? patient comes with haemorrhage and you replace the fluid but the fluids actually make the condition worse becuz the patient is already has of oedema . the lung is hypo perfusion so u need oxygen
- Pathology fracture will rupture the blood vassal that around the bone lead to move the fat from bone to blood vessale then to lung
- Petechial of skin & mucosa (appear above nipple line and blanch) Early recognition of FES is paramount to prevent morbidity and mortality. Minimizing movement of long bone fractures during care reduces the risk For patients in need of respiratory support the options may include: Intubation Ventilator management ICU monitoring
- Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE)
- Gold stander – mostly used Anticoagulation Heparin LMWH (low molecular weight heparin) Warfarin (Coumadin)
- - When muscle get damage muscle relase myoglubin
- if there is no signs of healing for more than 6 months after fractures called non union before this 6 months it will be delayed complication called Delayed union happens in very specific area ,when radius and ulna get fractured and mange them convetavly and then calus is formed we will have uniting bone together same with lower -Certain regions more than others include: Head of femur Proximal part of scaphoid Lunate Body of talus
- - local :could be at the site of injury or surrounding systematic : involve all the body #systemic: no deled complications at all. more dangerous than the local The worst things in local complication ampulate the limb - the worst things in systemic complication death